04/03/11 142 W, 1 I - + 3 - 0 New Option For 911 Callers in Charlotte: OMEGA

Friday, April 1, saw the launch of a new program for 911 callers in Charlotte and Mecklenburg County that's designed to help reduce responses for minor medical injuries. The program's called OMEGA and is a partnership with the county, the county EMS agency (Medic), and two hospital systems. Callers with minor medical problems will be connected to a nurse-staffed help line, and be advised on treatment options. They won't be denied an ambulance response, but given additional options perhaps more appropriate for their problems. How many such calls might qualify for the program? Out of last year's 98,000 calls, note officials, 1,100 would have fit the program. And that's the simple summary. Here are some links to learn more, and clarify whatever points Yours Truly has oversimplified.

The sad part is that a majority of the people that call that do not need to go to the emergency room are still going to want to go to the emergency room becasue the health department is not open at night and on weekends. They cannot go to urgent cares because they do not have any moeny. They do not have a primary care physician so they cannot go there. They are too busy spending their money on plasma TVs, Escalades, big wheels, tatoos, and other luxuries so they do not have moeny to buy Tylenol, Motrin, or the like. Until paramedics are trained to a standard to tell people they do not need an ambulance, and then held accountable for those decisions, nothing will change. We have spent forty plus years telling people to call 9-1-1 for whatever emergency, or rather, inconvenience they have and we will take care of it. We have created this problem. So therefore EMS calls will continue to rise, fire calls for EMS response will continue to rise, and ED crowding will continue to increase.

And this program does not even begin to address to hundreds of unnecessary nursing home transports scene by EMS in the course of a shift, mostly because the staff are not allowed to do things they are trained to do or because it is just too easy for a doctor to say “send them to the ER”.
Burned Out Medic - 04/04/11 - 10:39

This is just one of many approaches being implemented in this state to bridge the gap between available EMS units and requests for service. An additional step Mecklenburg County has taken is reinstating the basic truck. BLS trucks are now used my Medic to handle non-emergency transports and to handle BLS appropriate calls when ALS units are tied up or too far away.

Luckily for Wake County, I don’t believe the situation has become critical but this “gap” is looming. The APP program was a proactive attempt to reduce the demand on the 911 system. The OMEGA program and the APP program are trying to accomplish the same thing.

Another idea I have heard tossed around is placing higher level practitioners, even NPs and PAs, on ambulances to respond to some of the OMEGA calls and SNF calls that “burned out” refers to. The idea is to treat the patient at their home and avoid overcrowding the ED (another problem entirely). Any other ideas out there?
Andrew Wallace - 04/04/11 - 14:50

MEDIC has been “testing” this protocol out for some time by cancelling the fire truck and continuing the ambulance in non-emergency until the nurse line confrims the patient doesn’t need them. The problem I’ve noticied is that if (at any point) the patient says the “key words” (short of breath, chest pain, etc.) then the call bounces back up to an emergency response and fire is re-dispatched. Now, apparently MEDIC cancels their ambulance as well as fire cancelling off the call completely. With the number of times that fire is cancelled enroute and then re-dispatched to the same call a few minutes later, I’d be curious to find out how much this delays patient care for someone who has some type of prioirty symptom (or something that changes the call from Omega to Charlie/Delta).

The other issue that we’ve run into is that if fire isn’t advised that this will be an Omega call until after we get on scene, the firefighter’s hand’s are tied because they’re standing with a “patient” that is talking on the phone to a nurse. What do you do? You can’t abandon the patient, but you also have to realize that the questioning on the phone can take several minutes. I know MEDIC used to tell us to not approach the patient and interfere if they are talking on the nurse line, but sometimes we get on scene too quickly for them to notify us that it’s going to the nurse line.

Don’t get me wrong, this line is great for the patients that call 911 because they “can’t sleep, have a swollen toe, have a rash, etc.” but by no means do I think this system is flawless.

I, personally, like the idea of figuring out where the frequent flyers live and take a proactive approach to stop by their location and check in on them. Then again, this idea isn’t flawless either.
Luke - 04/05/11 - 09:33

MEDIC has been studying this program since 2003. I was involved with the study during the first phase. Calls classified as OMEGA were processed by 911 in the traditional manner, but these incidents were flagged and follow-up on. Key data from the paramedic incident report and the ED medical records were collected and analyzed to insure that when the program went online, patient care would not be compromised. As for the delay in FD arrival in the case of mis-classification, I would assume that true medical emergencies rarely, if at all, get classified as OMEGA. I assure you that data supporting or refuting this does exist; hopefully someone has looked at it.
Andrew - 04/05/11 - 12:04

NPs and PAs and RNs belong in the clinical setting & not the living room or the intersection. Call 911, we’ll sort it out, and no one will fall through the cracks
David - 04/05/11 - 12:47

David, unfortunately such an absolute and simplistic approach may not be good enough in the future. What good is calling 911 if there are no units available? Like I said, novel approaches will be needed in the future to meet rising demand and falling budgets. There are rural communities in Canada that I know of that have successfully implemented NP/PA special units that handle calls to avoid hospital transports. Obviously they won’t be practicing medicine in an intersection but they may yet have a place in living rooms; why can’t that be a clinical setting? Clearly Wake County is neither rural nor Canada, but EMS systems will need multi-pronged novel solutions to this problem.
Andrew - 04/05/11 - 21:15

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